Diabetes prevalence and diagnosis in US states: analysis of health surveys
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BioMed Central
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Research
Diabetes prevalence and diagnosis in US states: analysis of health surveys Goodarz Danaei*1,2, Ari B Friedman2, Shefali Oza2, Christopher JL Murray3 and Majid Ezzati1,2 Address: 1Harvard School of Public Health, Boston, Massachusetts, USA, 2Initiative for Global Health, Harvard University, Cambridge, Massachusetts, USA and 3Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA Email: Goodarz Danaei* - [email protected]; Ari B Friedman - [email protected]; Shefali Oza - [email protected]; Christopher JL Murray - [email protected]; Majid Ezzati - [email protected] * Corresponding author
Published: 25 September 2009 Population Health Metrics 2009, 7:16
doi:10.1186/1478-7954-7-16
Received: 5 March 2009 Accepted: 25 September 2009
This article is available from: http://www.pophealthmetrics.com/content/7/1/16 © 2009 Danaei et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract Background: Current US surveillance data provide estimates of diabetes using laboratory tests at the national level as well as self-reported data at the state level. Self-reported diabetes prevalence may be biased because respondents may not be aware of their risk status. Our objective was to estimate the prevalence of diagnosed and undiagnosed diabetes by state. Methods: We estimated undiagnosed diabetes prevalence as a function of a set of health system and sociodemographic variables using a logistic regression in the National Health and Nutrition Examination Survey (2003-2006). We applied this relationship to identical variables from the Behavioral Risk Factor Surveillance System (2003-2007) to estimate state-level prevalence of undiagnosed diabetes by age group and sex. We assumed that those who report being diagnosed with diabetes in both surveys are truly diabetic. Results: The prevalence of diabetes in the U.S. was 13.7% among men and 11.7% among women ≥ 30 years. Age-standardized diabetes prevalence was highest in Mississippi, West Virginia, Louisiana, Texas, South Carolina, Alabama, and Georgia (15.8 to 16.6% for men and 12.4 to 14.8% for women). Vermont, Minnesota, Montana, and Colorado had the lowest prevalence (11.0 to 12.2% for men and 7.3 to 8.4% for women). Men in all states had higher diabetes prevalence than women. The absolute prevalence of undiagnosed diabetes, as a percent of total population, was highest in New Mexico, Texas, Florida, and California (3.5 to 3.7 percentage points) and lowest in Montana, Oklahoma, Oregon, Alaska, Vermont, Utah, Washington, and Hawaii (2.1 to 3 percentage points). Among those with no established diabetes diagnosis, being obese, being Hispanic, not having insurance and being ≥ 60 years old were significantly associated with a higher
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